Presentation (CTI)

OBJECTIVES: Painful diabetic neuropathy (PDN) significantly impacts patients' quality of life and imposes a substantial economic burden. Despite multiple pharmacological treatments being available, limited real-world evidence exists comparing their cost-effectiveness. This study evaluates the cost-effectiveness of gabapentin, pregabalin, and duloxetine as first-line treatments for PDN using a real-world, single-center net benefit regression model.
METHODS: A cohort of 130 PDN patients admitted between January 2022 and June 2024 was analyzed, capturing demographic, clinical, cost, and outcome data. Incremental cost-effectiveness ratios (ICERs) were calculated from a healthcare system perspective. Sensitivity analysis and cost-effectiveness acceptability curves (CEACs) assessed robustness across different willingness-to-pay (WTP) thresholds.
RESULTS: Gabapentin had the lowest average treatment cost ($4.64 ±$1.25) and a treatment success rate of 63%. Pregabalin showed higher efficacy (70%) but incurred significantly higher costs ($26.20 ±$5.30). Duloxetine had moderate costs ($7.23 ±$2.10) but the lowest efficacy (35%). Gabapentin was found to be cost-saving and more effective compared with duloxetine, while pregabalin demonstrated higher costs for a modest improvement in effectiveness compared with gabapentin, resulting in an ICER of $215.59. Net benefit analysis indicated gabapentin’s dominance within WTP thresholds of $27.78-$69.44.
CONCLUSIONS: Gabapentin is the most cost-effective first-line treatment for PDN, particularly in moderate WTP ranges. Pregabalin is a viable alternative under higher WTP scenarios, whereas duloxetine is not recommended as a primary choice due to suboptimal cost-effectiveness.